PL-09-1035 'YH+
Miami Shores Village � � V °
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000 i
' Phone: (305)795- 2204
K �
!"toRtt - F v
Expiration: 12116120
Project Address Parcel Number Applicant
9650 5 Avenue Road 1132060170160
RICHARD COOPER }
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
RICHARD COOPER
9650 NE 5 AVE RD
MIAMI SHORES FL 33138 -2443
Contractor(s) Phone Cell Phone Valuation: $ 2, 300.00
STATEWIDE SEPTIC CONNECTIONS 305 - 661 -6633
Total Sq Feet: 0 _
Type of Work: PLUMBING For Inspections please call:
Type of Piping: DRAINFIELD (305)762 -4949
Additional Info: Available Inspections:
Bond Return : Inspection Type:
Classification: Residential Final
Rough
Landscaping
Fees Due Amount Invoice # Total Amt Paid Amt Due
Bond Type - Contractors Bond $300.00 PL -6 -09 -35149 $ 489.78 $ 489.78 $ 0.00
CCF $1.80
Education Surcharge $0.60 Check #• 1015 Bond #: 1862
Notary Fee $5.00
Permit Fee - Additions /Alterations $175.00
Scanning Fee $3.00
Technology Fee $4.38
Total: $489.78
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -nai red contractor to do the work stated.
June 19, 2009
Authorized Signature: Owner / Applicant / fontractor / Agent Date
Building Department Cop
June 19, 2009 1
Miami Shores Village
Building Department Ju 1 zoos
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: ( )05) BY :• -- -- - • - - - - --
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 200
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) Dgr�l Ile Gated r'i
G e% Phone # 0 S) 49 ° , O qG 4
Owner's Addrr -ess -! 6S� NE p ire
City �l �1 �-f S State Zip a3 13,3
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) 9 r0SC) N}_. F5 A ,
City Miami Shores Viltaee County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Ristorically Designated YES NO f/
Contractor's Company Name c ox idt� n C ck Phone # 66C• ro 633
Contractor's Address x`10 $ • —
City M f q,n A ✓' r State jZ Zip 3G23
Qualifier Name T- e5� oC0 .D� Phone #
State Certificate or Registration No. 1".fl - It 2 L Certificate of Competency No.
E -MAIL:
Architect /Engineer's Name (if applicable) Phone #
D
Value of Work For this Permit $ Square / Linear Footage Of Work: G OO
Type of Work: ❑Addition ❑Alteration nNew 2 Re air /Re lace
p p F1 Demolition
Describe' Work:
RIC12\9ALC
Submittal Fee Permit Fee $ 3 CCF $ 110 CO /CC
Notary $ - O Training /Education Fee $ __ Technology Fee $ `
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Zip -
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indi cated. t certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable taws regulating construction and zoning.
"WARNING TO OWNER: ; YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING 'YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2SOO, the 4pplicant must
promise in good faith that a copy of the notice of contmencenwo and cottowcdon lien law brochure w411 be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven ( days after the building permit is issued. 1n the ubse+gce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature --
Owner or Agent Contractor
The foregoing instrument was acknowledged me this The f o
UP
_ in�g was acknowledged bef this l
day of 2�, b D -e ,(Je C7oo day o J M[tJ 2 9M,by .TPA40
who is personally known tome or who has produced R- A, who is personal 'tome or who h roduced
�l�l Lt roc As:idfitf oath.
and who did take an oath.
NOTARY PUBLIC` "` {%omm# $ NOT Y P IC:
S4' 1q & M1
3� t q 1
ry;FtyF �
Sign: �. ®.' ...'..a� Sign:
Print: a Print: ,«..., �,' ,r
My Commission Expires: My Commission Expires: 164
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
06/18/2009 20:44 FAX IA001/002
PERMIT # : 13 -SC- 992623
STATE OF FLORIDA APPLICATION #. AP926570
DEPARTMENT OF HEALTH DATE pAXDO
ONSITZ SEWAGE TREATMENT AND DISPOSAL SEE PAID:
"qw SYSTLM
RECEIPT #:
Dommm #: PR777138
CONSTIWCTION PERMI FOR: OSTDS Repair
APPLICANT Danielle Goodman
PROPERTY ADDRESS: 9650 NE 5 Ave Miami, FL 33136
LOT; 24 +25 BLOCK: 66 SUBDIVISION:
PROPERTY ID 0: 11 -3206- 017 -0160 [SECTION, TOWNSHIP, RANGE, PARCEL NM4BER]
[OR TAX ID NUb=R]
SYSTEM MUST HE CONSTRUCTED IN ACCORDANCE SMITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, P.O., "D CHAPTER 64E -6, T.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TndE. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVID AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIF= THE
PER XT APPLICATION. SUCH MODIFICATIONS My RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMMNT OF THIS PROPERTY.
SYSTEM DESZ= AND SPECIFICATIONS
T [ 1,050 ] GALLONS / GPD Septic CAPAC
A [ 0 ] . GALZ,ONS / GPD CAPACITY
N [ 0 ] GALLONS dRSABE xNTERCEPTOR CAPACITY [MAXIMpM CAPACITY SINGLE TANK:1250 GALLONS]
K L 7 GALLONS DOSING TAM CAPACITY L ]GALLONS ]DOSES PER 26 EMS #Pumps [ ]
D [ 300 ] SQUARE FEET SYSTEM
R [ O ] SQUARE FEET S YSTEM
A TYPE SYSTEM: [ STANDARD [ ] FILLE t MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x1 BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 11.0 NGVD
I ELZVATION OF PROPOSED SYSTEM S TTE [ 19.20 INCBE9 FT ][ABOVE LORE SENCHARK/RZFERENCE POINT
E BOTTOM OF DRASNSIEI.D TO a8 [ 43.20 ] [ FT 1 [ ABOVE LOY BEN1CMamVRSF CE POINT
L
D SSLL REQUIRED: [ 0.00 ] INCHES EXCAVATION REQUIRED: [ 36.00 1 =elms
0 1,- Existing 1050 gel. septic tank, certified by "Statewide Septic on 06116109" to remain.
T
2.- Install 300 sf of dralnfleld In bed configuration. Use all UnobstruCed area for drainfield by rule 64E -6.0 ' (Drair�
area required Is SW at). `� O A F
8 3.- Invert elevation of drainfleld to be no less than 6.70' NGVD.
8 4. of drainfield elevation to be no teas then 6.20' NGVD. 000
R "'"**""*THIS PERMIT IS NOT FOR A0DITI0N(s) —W
SPECIFICATIONS BY: trL V Edx de TITLE: aaginear Spftcialiet xx
APPROVED BY: 6`�`� TITLE: Engineer Specialist xx Dade CED
Astrid V Edxsxds
DATE ISSUED: 06/18/2009 EXPIRATION DATE: 08116/2009
DS 4016, 10/91 (Pravlaua Edition& May Be Used) Pago 1 Of 3
V 1.1.4 AP926570 $E79o392
06/18/2009 20:45 FAX [a 001 /001
STATE OF FLORIDA
DEPANIMENT OF HEALTH
a „w APPLICATION FOR ONSrrE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT t, �,l ” t
Permit Application Number . 7a.. '
PART 11- SITE PLAN -
Scale: Each block represents 5 feet and 1 Inch - 50 feet. _
�o ;—.— j '
1 f 7 i 1 - I i I � f— I- -•r+— i j��'� I I I .� ! � j � '� '�, �• 1 I �i.
I ..I �' ! i I `_I� I i I _ F ' i y 1 i i I � i ..7 . .., I I 1 `�'1•p�4
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• I I i I I I j i� -�� .. 1 • � i ' t ' I I 1 , , y I ' ' . J * `�. ,— f _ !
1 i ,;
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• , i ,i.. .i ..i I : i I [i" 1 j ' .....r— i��.V, s • r •li , i r I - !~ ' ,� ,(
Notes: �' ; .-- �"*S�•�° '-- _
nn Q r4% -. G 16 ; S o t�E S Aec CZ--h 33138
Site Plan submitted by: r v� I�
Signature Tide
Plan Approy q Not Approved Dam
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
IN 401% 1Wft (PAq*m NFl&H Pam 4o1 T*hh may 0w uW)
M=k NUROW: 6744- =" Page 2 of 3
►„ Inspection Worksheet
Miami Shores Village
_ 10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Scheduled Inspection Date: June 25 2009 Permit Type: Plumbing - Residential
Inspector: Levrock, James
Inspection Type: Final
Owner: COOPER, RICHARD Work Classification: Drainfield
Job Address: 9650 NE 5 Avenue Road
Miami Shores, FL
Phone Number
Parcel Number 113206017016
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: 305 - 661 -6633
Building Department Comments
tr�
EK NW E
Passed
Failed
Correction ❑
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
t ,
V! roitirataPlealth
MVO Department of Elealth
-- de ('Ounty Health Department
j m
Well Division WO
St: • Miami, FL 33175
a
.�,.
Date
_�_ :. �X .
PERMIT NO.
5 , DATE PAID:
` "vi. N Al ? DISPOSAL SYSTEM
e car FEE PAID:
A FINAL APPROVAL RECEIPT #:
APPLICAN l : - - - -- - - - -- — —
AGENT:
-. -.., .
LOT-- -- " - -- s. -- - - - -- - - - -- PROPERTY ID #:
CHECKED. 3F WITH STATUTE OR RULE AND MUST BE CORRECTED.
SETBACKS
[ �
[271 SURFACE WATER FT
[28] DITCHES FT
[29] PRIVATE WELLS FT
[30] PUBLIC WELLS_ FT
.- - - - - -_. [ ] [3 ?j IRRIGATION WELLS FT
j [32] POTABLE WATER LINES FT
-
[ ] [33] BUILDING FOUNDATION FT
] [34] PROPERTY LINES FT
[ ] [35] OTHER FT
FILLED ! MOUND SYSTEM
; -
[36j €D;3AIN =TEED COVER
[ J
[371 SHOULDERS
:38 SLOPES
[ °`s 139] STABILIZATION
- ADDITIONAL INFORMATION
] [4 ] INOBSTRUCTED AREA
[41] STORMWATER RUNOFF
L _
]> ALARMS
[ _ , [43] MAINTENANCE AGREEMENT
44] BUILDING AREA
LOCATION CONFORMS WITH SITE PLAN
[46i FINAL SITE GRADING
-
1 [47] CONTRACTOR
[48j OTHER
. ,
B�NDON;'EN"i
[ 1 49]
TANK PUMPED _/
_ ,.. 5tij APBK CRUSHED &FILLED
EXP F N4
DATE:
'.. '. ;- - - -- CHD DATE:
DH 4016 Page 2 of 3
stock rlher
T is Applicant
PT 2: Insta{IeriCon'.ractor
PT 3: Building Department